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4 May 2018
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Working at scale is becoming more common for practices. As of 2016, over half the country had formed into networks or federations of practices, said Dr Arvind Madan, director of primary care at NHS England in the general practice forward view (GPFV).
In December 2017, a group of practice managers in Calderdale, West Yorkshire got together to discuss the possibility of working collaboratively.
With financial support from NHS England and guidance from the local GP federation, Pennine GP alliance, 10 practices got together to form Calderdale Group Practice (CGP).
By group buying services, the practices are projecting a total annual saving of £70,000 across all sites.
Practice manager at Plane Trees Group Practice in Halifax Tracy Dell told Management in Practice’s reporter Valeria Fiore how they have done it.
How it all began
‘It started with collaborative working. NHS England allocated some funding to help all the 26 practices in Calderdale to discuss the possibility to work together.
Some initial funding was released to have the meeting with all practices, and Pennine GP alliance facilitated that meeting session.
We wanted to look at things on a bigger scale but we thought initially we would focus on how to free up some time to work on the bigger projects.
The group was set up in December 2017. CGP is our registered company and we initially set it up to manage all our service contracts with the aim of moving towards a one invoice process for all 10 practices in the future.
How we are saving £70,000
‘We started looking at service contracts and we are signing group contracts rather than having our individual providers. With other practice managers, we have agreed that some contracts might not be making savings for everybody but overall, we have all benefitted from one contract or another. This has never resulted in anyone being out of pocket because what they have maybe lost on one contract was gained on another.
We have agreed it is for the greater good of our practices and it makes them more sustainable and reliable, as it means that we can rely on each other now.
We are going to sign contracts covering the following areas:
Other areas we are looking at include:
‘This is very early days for us but it is guaranteed that we will save £70,000. We have agreed for a new provider for accounts and most of the contracts are up and running.
The financial side of working together is definitely one of the greatest benefits.
However, CGP gave us the opportunity to support each other as practice managers: we talk about our concerns, our staff and developing our role in the future.
CGP is also saving us time because each one of us spends time reviewing only one contract but by working at scale, we automatically get all contracts covered.
This group will allow us to find out what our strengths are in different elements of practice management. It is already changing the way we work and it is going to make a massive difference to our monthly tasks. For instance, the new account that we have now appointed for all the 10 practices will now introduce digital accounting, so we will no longer do manual bookkeeping, it will all be electronic.
‘We are so used to work independently in general practice.
I think one of the biggest challenges is definitely about trusting one another to work together.
A lot of practices are taking on new ways of working. Take for instance electronic mail. A lot of practices were using franking machines, envelopes and printing and stamps. Now they are installing electronic software, and they are doing that because they have trusted that another practice has done that and it has worked for them.
Time is also a challenge. It takes time to get together and work together, and our GP partners have to agree to release us for a few hours a week to work on these projects and try to drive these efficiencies.
We meet monthly for four hours, two of which are for practice managers only and the remaining two for GP partners to join the discussion.’
Process – setting up the group
‘As practices, we underwent a due diligence process. That was a legal process, with solicitors support and directions.
We had to be very open and share lots of information about our organisations because we are looking to work together. It may be that the end result leads us to form a single organisation, but it may not be. We are only at stage one of this process and we are looking at what we can share, what we can do well and how we can work together and we pick service contracts as the first element of that process.
Tracy Worrall, operations manager at Spring Hall Group Practice in Halifax says: ‘The work CGP carried out for the due diligence prior to all the practices signing up to collaborative working at scale gave me a better idea of what contracts we held.’
Workforce is a real pressure for us at the moment and this will surely be our next area of focus. We are talking about sharing staff and workforce. We will then have to start looking at HR-related legislation and at contracts of employment.
We would also like to start specialist pathways, with GPs from each practice leading in particular areas of expertise across the group of practices.
The Calderdale Group Practices are: Plane Trees Group Practice (Tracy Dell), Spring Hall Group Practice (Tracy Worrall), Boulevard Medical Practice (Bev Barr), Bankfield Surgery (Claire Baggley), Caritas Group Practice (David Wright), Horne Street Surgery (Shama Hussain), Station Road Surgery (Claire Cox), Todmorden Group Practice (Tracy Wilson), Southowram Surgery (Liz Coulson) and Queens Road Surgery (Elaine Aderaye). Managers names in brackets.